Schools fight families over autism service dogs

At issue is whether the dogs are true ‘service’ pets or simply companions

Robin Scholz / AP Kaleb Drew, 6, grabs on to the tail of his autism service dog, Chewey, as they play in the backyard of their home after Kaleb's first day of school in Villa Grove, Ill., on Friday, Aug. 21. View related photos

CHICAGO - Like seeing-eye dogs for the blind, trained dogs are now being used to help autistic children deal with their disabilities. But some schools want to keep the animals out, and families are fighting back.

Two autistic elementary school students recently won court orders in Illinois allowing their dogs to accompany them to school. Their lawsuits follow others in California and Pennsylvania over schools' refusal to allow dogs that parents say calm their children, ease transitions and even keep the kids from running into traffic.

At issue is whether the dogs are true "service dogs" — essential to managing a disability — or simply companions that provide comfort.

School districts say they are not discriminating, just drawing the line to protect the safety and health of other students who may be allergic or scared of dogs.

"The school district has 650 students, not just one. So we have to balance," said Brandon Wright, attorney for the Villa Grove district in central Illinois, which objected to 6-year-old Kaleb Drew's plan to bring his yellow Labrador retriever, Chewey, to school.

Kaleb's family won a judge's order in July allowing the dog to come to class until a trial, set to start Nov. 10. That means when Kaleb starts his first full day of first grade Monday, Chewey will be by his side.

Service dogs have long been used by the blind, but training them to help those with autism is relatively new. While there's little research on how these animals affect autistic children, families like Kaleb's say they have seen marked improvement. And the support group Autism Speaks includes a list of dog-training groups among resources on its Web site.

Autism is a developmental disorder that involves behaviors such as poor eye contact, trouble communicating and repetitive movements such as rocking or hand-flapping. Those with the disorder are prone to outbursts and may have trouble with changes in their environment.

Calming canine influence
The dogs are trained to be a calming influence, providing a constant between home, school and other new places. Sometimes, as in Kaleb's case, the dogs are tethered to children to prevent them from running off in dangerous situations.

"It's done so much more than we thought it could," said Kaleb's mother, Nichelle Drew. "We want Kaleb to be able to experience more of life," and the dog has helped him do that, she said.

Chewey does not react when Kaleb "throws a fit" during times of transition from one activity to another, which calms him much more quickly, Drew said.

The tether fitted around Kaleb's waist helps the dog stop Kaleb from running into traffic at pickup time, as he is prone to do.

Under the federal Americans with Disabilities Act, "a person with autism would be considered a person with a disability in nearly all cases, and a service animal is any guide dog, signal dog or other animal individually trained to provide assistance to someone with a disability," said Alejandro Miyar, a spokesman for the Department of Justice.

Miyar declined comment on specific cases but said schools are required to make accommodations for disabled students to use a service animal. Illinois is among several states with similar laws.

Schools, though, can argue that the animals do not provide a functional service. Wright said Kaleb's school already provides him with adequate special services. Officials believe Chewey is more of a companion or comfort dog, not a true service dog.

Elizabeth Emken, vice president of government relations for Autism Speaks, said her 17-year-old autistic son has used a service dog for about two years.

Emken said the dog helps control her son's pacing and circling, but the family opted against allowing the boy to take the dog to school because she did not know if he would be able to manage the dog effectively.

Weighing the pros and cons
"Personally, I can see the pros and cons" of allowing the animals in schools, Emken said, though she believes schools should not ban the assistance.

Families of autistic kids elsewhere have fought similar battles, including recent cases in Manteca, Calif., about 70 miles northeast of San Francisco, and North Franklin Township, Pa., near Pittsburgh.

And cases involving other disabilities, including deafness and diabetes, have cropped up in other states.

On Thursday, a judge sided with a family in Columbia, near St. Louis, that sued over their school district's unwillingness to allow an autism service dog in a special education pre-kindergarten classroom.

Still, 5-year-old Carter Kalbfleisch will not have the dog with him when he starts classes Monday. A hearing is scheduled that day so the school can work out the logistics of accommodating the dog, which his family credits with helping stop the boy from running off and keeping him from eating things like rocks.

The case still could head to trial, though the family's attorney, Clay St. Clair, said Friday the initial ruling is based on the Illinois law allowing service animals in school. The district did not return calls.

"I don't know if it would have been a simpler issue if we were dealing with a guide dog or something the school board was a little more familiar with," St. Clair said.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

CDC: No ‘red flags’ in swine flu vaccine tests

No side effects seen 10 to 14 days after first studies in adults

	A nurse tests a woman for swine flu on Thursday at the Noumea flu treatment center in the French Pacific territory of New Caledonia. View related photos
Marc Le Chelard / AFP - Getty Images

Back-to-school swine flu checklist Aug. 17: What can you do to keep your kids safe and healthy when they return to school? NBC’s chief medical editor, Dr. Nancy Snyderman, has tips to help keep children safe from the swine flu this back-to-school season.

Swine flu vaccine testing on humans CDC: Screen schools for H1N1 Swine flu trials under way Priorities set for swine flu vaccine

Interactive map

Flu activity around the country A state-by-state look at the geographical spread of both seasonal flu and swine flu (H1N1) in the United States.

Q&A

Swine flu Learn about the virus found in pigs and why it is causing concern among health officials. msnbc.com

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Discuss: How concerned are you? Tell us: Are you making changes to prevent infection? Vote: Would you wear a face mask? Poll: Have you changed your travel plans? Poll: Would you stay home if swine flu spread to your city? Ask us your questions about swine fl

Clinical trials for the new swine flu vaccine have turned up no "red flags," U.S. health officials said on Friday.

The first results from studies of the new vaccines in adults and the elderly will be available in mid-September, but so far, the only complaints seem to be a bit of local soreness and redness in the arm at the injection site, they said.

"There are no red flags regarding safety," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health.

Fauci said no side effects were seen 10 to 14 days after the first studies in adults, giving health officials the confidence to start trials of the vaccines in children this week.

There is no sign yet of whether the new vaccines will produce enough of an immune response to protect people against the new pandemic H1N1 flu.

Two trials are underway in adults for the safety and effectiveness of two doses of the vaccine. The trials, which are also looking at whether one or two vaccinations will be needed, are nearly fully enrolled.

"We expect first dose data somewhere around mid-September if all goes well, and second dose data by mid-October," Fauci said in a telephone news briefing.

He said first dose data from the trial in children will be available in late September, and second dose data will be ready in late October.

Fauci said studies in pregnant women should begin in early September, as will studies using an immune system booster called an adjuvant. In all, the vaccines will be tested on nearly 4,600 people.

The Centers for Disease Control and Prevention said swine flu is still spreading widely across the United States, with 75 percent of serious cases and 60 percent of deaths among people under the age of 49. Alaska and Maine had "widespread" activity.

CDC has officially confirmed 7,963 hospitalizations and 522 deaths from the pandemic H1N1 flu, said CDC's Dr. Jay Butler. He said there were likely more than a million actual cases, as most patients never get tested.

"It is important to remember that at this time of year we don't normally have influenza," Butler said.

‘Explosion’ in case numbers
On Friday, the World Health Organization warned that the global spread of swine flu will endanger more lives as it speeds up in coming months and governments must boost preparations for a swift response.

WHO's Western Pacific director Shin Young-soo predicted there will soon be a period of further global spread of the virus, and most countries may see swine flu cases double every three to four days for several months until peak transmission is reached, said

"At a certain point, there will seem to be an explosion in case numbers," Shin told a symposium of health officials and experts in Beijing. "It is certain there will be more cases and more deaths."

WHO has declared the swine flu strain a pandemic, and it has killed almost 1,800 people worldwide through last week. International attention has focused on how the pandemic is progressing in southern hemisphere countries such as Australia, which are experiencing winter and their flu season.

WHO earlier estimated that as many as 2 billion people could become infected over the next two years — nearly one-third of the world's population.

Separately, in new advice issued to health officials, the WHO said healthy people who catch swine flu don't need antiviral drugs like Tamiflu. Rather than using it to treat healthy people, the drug should be used to treat people in groups at risk for the virus. That includes children less than five years old and people over age 65, among others.

The new advice contradicts government policies such as those in Britain, which has been giving out Tamiflu to all people suspected of having swine flu.

In the U.S., Fauci said the government expected to have 45 million to 52 million swine flu vaccine doses by mid October, when vaccination is expected to begin, and 195 million by the end of the year.

Fauci said even after people are vaccinated they should be aware they are not immediately protected — the immune response from a vaccine takes about two weeks to develop.

Five companies are making both seasonal and H1N1 flu vaccines for the U.S. market —AstraZeneca's MedImmune unit, CSL, GlaxoSmithKline Plc, Novartis AG and Sanofi-Aventis SA.

Fauci said he expects an upsurge of flu cases in the autumn, as weather cools and students return to school. U.S. government officials have urged schools and businesses to encourage people to stay home when they are sick, to wash their hands frequently and keep workspaces clean.

Butler said reports from Chile that turkeys have become infected with H1N1 virus are not a surprise. "Because of the swine characteristics of this virus, it can have the capacity to infect turkeys," he said.

Hospitals may be overwhelmed
WHO has stressed that most cases of swine flu are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities, especially in poorer countries.

Shin said governments must act quickly to educate the public, prepare their health systems to care for severe cases and protect those deemed more vulnerable to prevent unnecessary deaths.

"We only have a short time period to reach the state of preparedness deemed necessary," Shin said. "Communities must be aware before a pandemic strikes as to what they can do to reduce the spread of the virus, and how to obtain early treatment of severe cases."

Pregnant women face a higher risk of complications, and the virus also has more severe effects on people with underlying medical conditions such as asthma, cardiovascular disease, diabetes, autoimmune disorders and diabetes, WHO chief Margaret Chan said in a video address.

Anorectal Abscess

The last phase of the digestive process is the collection of and passing from the body of solid wastes. These wastes (what's left of what we eat after the water and nutrients have been taken by our bodies) collect in the rectum and then are expelled through the anus.

The inside of the anus is lined with glands and four to six crypts or pockets. Sometimes one of these pockets gets filled with stool. This can cause the gland to become infected and develop an abscess.

Symptoms

Signs of an anorectal abscess include:

• Fever
• A vague feeling of being unwell or uncomfortable
• Swelling and discomfort around or near the anus
• Redness around the area
• Drainage of pus or fluid from the area

Causes and Risk Factors

This type of abscess is usually happens when the glands in the area of the anus or rectum become infected. When an infection occurs in a gland, it can create a cavity that fills with pus. The cavity swells and causes constant pain and discomfort. The skin may look red and swollen and drain pus.

Diagnosis

A doctor will take the patient's medical history and do a physical examination. Diagnosis will be based on the symptoms and the presence of pain or tenderness, swelling, redness and possible drainage of pus from the area.

The presence of a fever or an elevated white blood cell count as measured by a blood test can confirm the presence of an infection in the body.

Treatment

Antibiotics alone are rarely enough to treat this type of infection. Usually surgical drainage is required.

In about half the cases where an abscess has drained, a fistula (an opening between the inside of an anal pocket or gland where the infection started and the outside of the body where it drained) can develop. A fistula will not heal without treatment that involves removing the pocket where the infection started.

Resources at Cedars-Sinai

Atrial Fibrillation

Atrial fibrillation occurs when electrical impulses in the upper chambers of the heart (atria) begin in multiple sites in a chaotic pattern and are sent rapidly to the heart's lower chambers, causing them to contract irregularly and quickly. The fibrillation or irregular heartbeat can occur for a few minutes, weeks or can continue for a lifetime. Episodes of atrial fibrillation that are brief or intermittent are termed "paroxysmal" while episodes that last longer requiring treatment are referred to as "persistent."

During atrial fibrillation, the atria do not pump blood as effectively as they normally should. In some cases, blood in the atria, which is not being pumped out effectively, can stagnate and clot. If these clots break up or break off, they may pass into the left ventricle, travel through the blood stream and block a smaller artery. If this happens in the brain, it can cause a stroke. Therefore, diagnosis, careful monitoring and treatment are all important aspects of managing atrial fibrillation.

Symptoms of Atrial Fibrillation

Symptoms of atrial fibrillation depend on how rapidly the heart is beating. If it remains below 120 beats a minute, there may be no symptoms other than the irregular or increased pulse. If the rate is higher, there may be heart palpitations or discomfort felt in the chest.

Other symptoms may include:

• A feeling of weakness
• Dizziness or faintness
• Shortness of breath
• Chest pain, especially in adults who are older than 65
• Rarely, blood pressure may fall and cause shock. This usually only occurs in individuals who also have severe heart disease.

Causes and Risk Factors of Atrial Fibrillation

Atrial fibrillation can be caused by heart diseases, such as coronary heart disease, high blood pressure, congestive heart failure or abnormalities of the heart valves. They can also be caused by another conditions, such as alcohol abuse, an overactive thyroid gland (hyperthyroidism), or a birth defect affecting the heart. Rheumatic fever (which often leads to damage to heart valves) and high blood pressure cause the atria to enlarge, making atrial fibrillation more likely. The risk of atrial fibrillation and atrial flutter also increase with age.

Abdominal Pain - Unexplained

Pain and other abdominal symptoms can signal any number of problems. These range from indigestion to cancer.

Symptoms

Some of the more serious conditions associated with abdominal pain include:

• Acute pancreatitis may cause general, constant and worsening pain in the upper abdomen. Sometimes the pain moves to the upper back. Other possible symptoms are weakness, shortness of breath and nausea.
  
• Appendicitis starts as general abdominal pain that settles into the lower right side.
  
• Biliary colic can cause a steady ache in the upper right abdomen. Sometimes the pain spreads to the upper back. Patients may also experience nausea and vomiting.
  
• Crohn's disease can present symptoms similar to appendicitis. These include pain in the lower right side and bloody diarrhea.
• Diverticulitis can cause moderate pain in the lower left side of the abdomen that grows worse over time.
  
• Gallstones may produce severe, cramping pain in the lower right part of the abdomen. Pain may spread to the back.
• Gastroesophageal reflux disease (GERD) causes a burning sensation or discomfort after eating. This occurs especially when the patient is lying down or bending over. GERD may also produce pain in the chest that awakens the patient at night. Other symptoms can be very similar to those of a heart attack.
  
• Hepatitis may cause pain in the upper right abdomen, nausea and vomiting.
  
• Pancreatic cancer may produce the same symptoms as pancreatitis.
  

Treatment

New technologies, such as video cameras that can be swallowed, are now available. These cameras can help diagnose gastrointestinal problems, including unexplained abdominal pain, bleeding with an unknown cause or anemia.

The tiny video camera is swallowed and then eliminated in about 24 hours. The camera sends data to receivers placed on the patient's body. A recorder worn on the patient's belt collects the data. Using special software, the doctor can process the data and produce a video with information from the digestive tract. The camera itself is disposable. Patients can continue normal daily activities while the camera is working.

Resources at Cedars-Sinai

• Samuel Oschin Comprehensive Cancer Institute
• GI Motility Program
• Inflammatory Bowel Disease Center
• Pancreatic and Biliary Diseases Program
• Pediatric Inflammatory Bowel Disease Center

Why Haven't I Ever Heard of Biotoxins, Neurotoxins or Biotoxin Illness Before?

You probably have heard of it, only it was called something else like Chronic Fatigue Syndrome (CFIDS), Fibromyalgia, Chronic Lyme Disease (CLD), Mold Illness, or ADHD (see "Other Names for Biotoxin Illnesses" below). The discoveries and the science behind how biotoxins and neurotoxins are involved in these illnesses and disorders is fairly new. The goal of this site is to provide information to both patients and physicians, to increase awareness regarding causes of Biotoxin Illness and highlight new clinical treatment discoveries. In the few months our new site has been up, we have reached many people, mainly in the United States and Europe. Many MD's are adopting Dr. Shoemaker's protocols and we are working on providing formal training for those individuals. Biotoxin Illness is still controversial and we are working to publish new peer-reviewed papers that can start to change the way doctors currently think. In the meantime, patients must continue to advocate for their rights and pursue the treatments that they feel are best for them. Ritchie Shoemaker, MD presented some fairly recent Chronic Fatigue research and treatment findings at The International Association for Chronic Fatigue Syndrome conference held in Fort Lauderdale, Florida in January of 2007. We have also just completed a soon to be published ground-breaking study on the health effects of mold exposure. Many progressive doctors around the country endorse the use of our on-line BIRS© test and the cholestyramine-based treatment protocol pioneered by Ritchie Shoemaker, MD. Remember though, that medical advances are ultimately driven through peer-reviewed publication in medical journals. These studies are expensive and time consuming and our recent peer-reviewed publications will help advance these discoveries into mainstream medicine. Many more doctors are becoming aware of biotoxins and the role they play in chronic illness.

That said, many leading experts in mold illness and exposure, chronic fatigue syndrome (CFIDS), fibromyalgia and Acute or Chronic Lyme Disease (CLD) are familiar with, and use our screening test and cholestyramine protocol. For example, Dr. Jacob Teitelbaum, Chief Medical Officer of the Fibro and Fatigue Center Clinics, has included a chapter on Dr. Ritchie Shoemaker's biotoxin discoveries and how they relate to CFIDS and Fibroymylgia in the updated revision of his book titled From Fatigued to Fantastic!, which was published in 2007. Additionally, Dr. Shoemaker testified about the human health effects of mold exposure for the US Congress in January of 2006.

Biotoxins play a large role in Chronic Lyme Disease (CLD) and our research in this area is recognized by many preeminent Lyme Literate MD's (LLMD's). A recent presentation summarizing the role of biotoxins in Lyme Disease was given by ILADS member Eric Gordon, MD and is available by clicking here . Another example is found in the monograph Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses , published in 2005 by Joseph Burrascano, MD, (click here for the webcast of Dr. Burrascano speaking about Neurotoxins/Biotoxins in Lyme Disease. He acknowledges that:

"Two groups have reported evidence that Borrelia, like several other bacteria, produce neurotoxins. These compounds reportedly can cause many of the symptoms of encephalopathy, cause an ongoing inflammatory reaction manifested as some of the virus-like symptoms common in late Lyme, and also potentially interfere with hormone action by blocking hormone receptors. At this time, there is no assay available to detect whether this compound is present, nor can the amount of toxin be quantified. Indirect measures are currently employed, such as measures of cytokine activation and hormone resistance. A visual contrast sensitivity test (VCS test) reportedly is quite useful in documenting CNS effects of the neurotoxin, and to follow effects of treatment. This test is available at some centers and on the internet.

It has been said that the longer one is ill with Lyme, the more neurotoxin is present in the body. It probably is stored in fatty tissues, and once present, persists for a very long time. This may be because of enterohepatic circulation, where the toxin is excreted via the bile into the intestinal tract, but then is reabsorbed from the intestinal tract back into the blood stream. This forms the basis for treatment."